Proliferative Diabetic Retinopathy

Proliferative diabetic retinopathy continues to be a major cause of blindness throughout the world. The natural history demonstrates that its development is primarily related to progressive retinal ischemia from diabetic retinopathy. The primary complications leading to vision loss, tractional retinal detachment and vitreous hemorrhage, are dependent upon the relationship between the neovascular tissue and the vitreous. The major risk factors are duration of diabetes and the level of glycemic control of the patient, with glycemic control being the modifiable risk factor as demonstrated in the DCCT/EDIC and UKPDS trials. Timely treatment with laser photocoagulation has been demonstrated to be of immense value for the preservation of vision, as reported by the DRS, ETDRS, and other studies. Pars plana vitrectomy is indicated for some patients with vitreous hemorrhage, retinal detachment, and other complications. With growing understanding of the cell biology of diabetes complications, pharmacologic therapies are emerging as promising treatment options.